Burden of Maternal Obesity on Congenital Anomalies: Implications and Future Trend

  • Arindam Bharadwaz Aarhus University Hospital, Aarhus, Denmark
  • Gayatri Madhab
Keywords: Body Mass Index, Obesity, Congenital Anomalies, Congenital Heart Defects, Neural Tube Defects, Oro-Facial Anomalies.


Obesity is linked to certain congenital anomalies viz. neural tube defects (NTD), congenital heart disease (CHD) and oro-facial anomalies. However the exact burden of obesity on congenital anomalies, its economic implications and future trend have not been well documented before. We present a thorough review of the current literature with deductive interpretations to arrive at the following observations. Congenital anomalies in general are a leading cause of infant and child mortality but they are on decline in many countries. However maternal obesity is on the rise. As a result, the share of maternal obesity contributing to congenital anomalies is likely to increase in future. Maternal obesity can therefore significantly contribute to perinatal mortality and its economic, social and psychological impact can be substantial.

Author Biography

Arindam Bharadwaz, Aarhus University Hospital, Aarhus, Denmark
Consultant, Department of Radiology, Aarhus University Hospital, Denmark andResident, Dept. of Obstetrics and Gynaecology, Vendsyssel Hospital Bispensgade 37, 9800 Hjorring, Denmarkrespectively


1. World Health Organization: Obesity and overweight. Fact sheet No. 311. Updated January 2015. Available at http://www.who.int/media- centre/factsheets/fs311/en/

2. Heslehurst N, Ells LJ, Simpson H, et al: Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36 821 women over a 15-year period. BJOG 2007;114:187-194

3. Roman H, Goffinet F, Hulsey TF, et al: Maternal body mass index at delivery and risk of cesarean due to dystocia in low risk pregnancies. Acta Obstet Gynecol Scand 2008;87:163-170

4. Salihu HM, Lynch O, Alio AP, et al: Obesity subtypes and risk of spontaneous versus medically indicated preterm births in singletons and twins. Am J Epidemiol 2008;168:13-20

5. Sahu MT, Agarwal A, Das V, et al: Impact of maternal body mass index on obstetric outcome. J Obstet Gynaecol Res 2007;33:655-659

6. Leung TY, Leung TN, Sahota DS, et al: Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women. BJOG 2008;115:1529-1537

7. Davies GAL, Maxwell C, McLeod L, et al; Society of Obstetricians and Gynaecologists of Canada: SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet 2010;110:167-173

8. World Health Organization: Global database on body mass index: BMI classification. Available at http://apps.who.int/bmi/index.jsp? introPage=intro_3.html.

9. Moore LL, Singer MR, Bradlee ML, et al: A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology 2000;11:689-694

10. Watkins ML, Botto LD: Maternal prepregnancy weight and congenital heart defects in offspring. Epidemiology 2001;12:439-446

11. Ray JG, Wyatt PR, Vermeulen MJ, et al: Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol 2005;105:261-265

12. Biggio JR Jr, Chapman V, Neely C, et al: Fetal anomalies in obese women: The contribution of diabetes. Obstet Gynecol 2010;115(2 Pt 1):290-296

13. Feldman B, Yaron Y, Critchfield G, et al: Distribution of neural tube defects as a function of maternal weight: No apparent correlation. Fetal Diagn Ther 1999;14:185-189

14. World Health Organization: Congenital anomalies. Fact sheet No.370, October 2012. Updated April 2015. Available at http://www.who.int/mediacentre/factsheets/fs370/en/

15. Anderson JL, Waller DK, Canfield MA, et al: Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005;16:87-92

16. Hendricks KA, Nuno OM, Suarez L, et al: Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans. Epidemiology 2001;12:630-635

17. Honein MA, Moore CA, Watkins ML: Subfertility and prepregnancy overweight/obesity: Possible interaction between these risk factors in the etiology of congenital renal anomalies. Birth Defects Res A Clin Mol Teratol 2003;67:572-577

18. Shaw GM, Todoroff K, Schaffer DM, et al: Maternal height and pre- pregnancy body mass index as risk factors for selected congenital anomalies. Paediatr Perinat Epidemiol 2000;14:234-239

19. Dolk H, Loane M, Garne E: The prevalence of congenital anomalies in Europe. Adv Exp Med Biol 2010;686:349-364

20. EUROCAT Prevalence Data Tables: Cases and prevalence (per 10,000 births) of all congenital anomaly subgroups for all registries, from 2007–2011. Available at http://www.eurocat-network.eu/

21. Boyd PA, Tonks AM, Rankin J, et al; BINOCAR Working Group: Monitoring the prenatal detection of structural fetal congenital anomalies in England and Wales: Register-based study. J Med Screen 2011;18:2-7

22. BINOCAR (British Isles Network of Congenital Anomaly Registers) – Congenital anomaly statistics 2010. July 2012. Available at http://www.binocar.org/content/Annual%20report%202010%20FINAL%2031_07_12.pdf.

23. National Audit of Treatment for Congenital Heart Disease, NICOR, UCL. Available at http://fetalanomaly.screening.nhs.uk/fetalanomalyleafletsforprofessionals.

24. Rankin J: Impact of Maternal Obesity on Neural Tube Defects and Cardiovascular Anomalies. 11th EUROCAT European symposium, Antwerp, Belgium, June 17, 2011

25. Original data source: Office of National statistics. Birth Statistics 2008. Series FM1 No. 37. September 14, 2010. Available at www.ons.gov.uk

26. Bell R, Tenant PWG, Rankin J: Fetal and infant outcomes in obese pregnant women. In Maternal Obesity. Edited by MW Gillman, L Poston. New York, Cambridge University Press, 2012, pp 56-69

27. National vital statistics reports. Vol 61. No. 4, May 8, 2013. Deaths: final data for 2010 by Murphy SL, Xu J, Kochanek KD. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.

28. Office of National Statistics. Mortality Statistics, Childhood, Infant and Perinatal. Review of the National Statistician on deaths in England and Wales, 2007. Series DH3, No. 40. London, Office of the National Statistics, 2009

29. Kurinczuk JJ, Hollowell J, Boyd PA, et al: The contribution of congen- ital anomalies to infant mortality. National Perinatal Epidemiology Unit, University of Oxford, June 2010. Available at https://www.npeu.ox.ac.uk/downloads/files/infant-mortality/Infant-Mortality-Briefing-Paper-4.pdf

30. Center for disease control and prevention data on congenital heart defects. Available at http://www.cdc.gov/ncbddd/heartdefects/ data.html.

31. United States Environmental Protection Agency: Birth Defects Prevalence and Mortality. Available at cfpub.epa.gov/eroe/index.cfm?fuseaction=detail.viewInd&lv=list.listbyalpha&r=239796&subtop=381.

32. Prevalence of obesity (with 95% confidence intervals) in females aged 16–44 years during the period 1993–2010. Available at www.noo.org.uk/NOO_about_obesity/maternal_obesity/uk_trends.

33. Ogden CL, Carroll MD: Prevalence of overweight, obesity and extreme obesity among adults: United States trends 1960-1962 through 2007-2008. Available at www.cdc.gov/nchs/data/hestat/obesity_ adult_07_08/obesity_adult_07_08.htm.

34. Fisher SC, Kim SY, Sharma AJ, et al: Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003– 2009. Prev Med 2013;56:372-378
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